Health Economics and Outcomes Research, Abbott Nutrition, Chicago, IL, USA.
Health Economics, EconoPharma Consulting, Mexico City, Mexico.
Clin Nutr ESPEN. 2021 Apr;42:195-200. doi: 10.1016/j.clnesp.2021.01.041. Epub 2021 Feb 10.
In Mexico, about half of hospitalized patients are malnourished or at risk of malnutrition upon hospital admission, while many others experience deterioration of their nutritional status while in the hospital. Such patients often experience poor health outcomes and have increased hospital costs. The aim of our budget-impact analysis was to estimate potential savings associated with the implementation of a Mexican hospital-based program of nutrition care for patients at malnutrition risk or malnourished.
The budget-impact model was based on data published previously. Our model compared patients assigned to receive individualized early nutrition therapy (initiated within 24-48 h of hospital admission) with those who received standard delayed nutrition therapy (not initiated early). Outcomes included length of stay, infectious complications, and 30-day readmissions. We modeled a 30-day time-horizon, estimated event probabilities on the basis of published data, and projected costs in 2020 US dollars.
Average total healthcare costs over 30-days were $3527 for patients with early nutrition therapy vs $6032 for patients with standard nutrition therapy-a savings of $2505 per early nutrition-treated patient (41.5% lower). Cost differences between the groups were $2336 vs $3065 for hospital-associated costs (23.8% lower), $262 vs $780 for 30-day readmissions (66.4% lower) and $1348 for malnutrition-associated infections. Applying these potential savings from individualized early nutrition care to a one-year estimate of 3.22 million Mexican hospital patients with malnutrition or its risk, the total overall savings for public health expenditures was equivalent to $8.1 billion per year or 32.1% of total healthcare expenditures.
The results demonstrated the potential for hospital-based nutrition care programs to reduce costs of patient hospitalizations. These notable findings provide a rationale for Mexican healthcare institutions to implement programs of comprehensive nutrition-focused care for inpatients with malnutrition or its risk. To this end, we advise implementation of professional programs for education and training in order to increase awareness of patients' nutritional needs and to better prepare clinical personnel to identify, treat, and monitor patients at-risk/malnourished.
在墨西哥，约有一半住院患者入院时存在营养不良或存在营养不良风险，而其他许多患者在住院期间其营养状况会恶化。这些患者往往健康状况较差，住院费用增加。本预算影响分析旨在评估为存在营养不良风险或营养不良的患者实施基于墨西哥医院的营养护理方案所带来的潜在节省。
该预算影响模型基于先前发表的数据。我们的模型比较了接受个体化早期营养治疗（入院后 24-48 小时内开始）的患者与接受标准延迟营养治疗（未早期开始）的患者。结果包括住院时间、感染性并发症和 30 天再入院。我们建立了一个 30 天的时间范围，根据已发表的数据估计事件概率，并预测了 2020 年的美元成本。
接受早期营养治疗的患者在 30 天内的平均总医疗保健费用为 3527 美元，而接受标准营养治疗的患者为 6032 美元-每个接受早期营养治疗的患者节省 2505 美元（节省 41.5%）。两组之间的费用差异为：与医院相关的费用减少 2336 美元对 3065 美元（降低 23.8%），30 天再入院减少 262 美元对 780 美元（降低 66.4%），营养不良相关感染减少 1348 美元。将这种个体化早期营养护理的潜在节省应用于 322 万墨西哥营养不良或有营养不良风险的住院患者的一年估计值，公共卫生支出的总体节省相当于每年 81 亿美元，占总医疗保健支出的 32.1%。
结果表明，基于医院的营养护理方案有可能降低患者住院费用。这些显著的发现为墨西哥医疗机构实施针对营养不良或有营养不良风险的住院患者的全面营养为重点的护理方案提供了依据。为此，我们建议实施专业的教育和培训计划，以提高对患者营养需求的认识，并使临床人员更好地识别、治疗和监测有风险/营养不良的患者。
